tricuspid valve: imaging and quantification. the role of ... · imaging and quantification. the...
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Tricuspid Valve:Imaging and Quantification.
The Role of the Right Ventricle
Theodora A Zaglavara, MD, PhD
Cardiologist – Cardiac Imaging Department
INTERBALKAN MEDICAL CENTER THESSALONIKI
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No Disclosures
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Anatomy of the Tricuspid Valve
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Goals of Imaging• TR severity
• TR severity
• TR mechanism
• Mode of leaflet coaptation
• Degree of tricuspid annulus enlargement and tenting
• RA dimensions
• RV morphology and function
• PASP
• Planning for Interventions
Imaging Modalities
• 2-D TTE /TEE Echo
• 3-D TTE/TOE Echo
• Cardiac CT
• Cardiac MRI
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Mechanism of TR -2D Echo EbsteinAnomaly
Myxomatous TraumaticIatrogenic
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Mechanism of TR -2D Echo
Post MVRRV dysfunction
ASD – LR shunt
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Which Leaflet in Which View? The Added Value of 3-D Imaging
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3-D TTE Location of Lead Device Position and Mechanism of TR
Mediratta et al, JACC Imaging 2014
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3-D Echo: New Insights into Functional Tricuspid Regurgitation
Mechanisms • Pulmonary Hypertension• Papillary muscle
displacement• Annular dysfunction or
dilatation
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The Complex- Dynamic Nature of the Tricuspid Annulus
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The Complex- Dynamic Nature of the Tricuspid Annulus
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Tricuspid Annulus Shape and Dimensions by Cardiac CT
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Assessment of Tricuspid Regurgitation Severity
✓ Grading TR severity is in principle similar to MR
✓ However TR is more load dependent than MR
✓ The color flow area of the regurgitant jet is not
recommended to quantify the severity of TR
✓ The color flow imaging should only be used for diagnosing
TR
✓ A more quantitative approach is required when more than a
small central TR jet is required
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Echocardiographic Evaluation of TR Severity
Vena Contracta
The systolic hepatic flow reversal is specific for severe TR. It represents the strongest additional parameter for evaluating TR severity.
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Quantitative Echo Assessment of TR Severity : EROA and Regurgitant Volume
PISA radius: 0.82 cm EROA =0.53 cm²TR VTI= 91.4 cm TR RV:49 ml
3-D Vena Contracta Area : Good correlation with EROA
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CMR in TR and Right Heart Visualization & Quantitation
Severe TR is defined as TR jet area > 10 cm2, ratio of jet-right atrium (RA) area > 35%, regurgitant orifice area > 40 mm2, and VC > 7 mm (arrows).
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The Complex Relationship between TR and RV function
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Tricuspid Valve Annulus Size and Degree of Tenting is Related to RV Remodeling
Tending Distance > 0.8 cmTending Area>1 cm² -Severe TR
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Chronic Severe TR always leads to dilated RV and RA
Conventional echo variables of RV function and even 3D or CMR derived RV ejection fraction are well known to be load dependent and not to be a proper reflection of RV contractility.The real impact of severe TR on intrinsic RV contractile function and on its potential reversibility is therefore difficult to assess.Preserved RV function variables in the presence of significant TR are always associated with a better prognosis than altered ones.
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RV Function: Keep it Simple!
3D RVEF < 45% is considered abnormalTAPSE <15 mm indicates significantly reduced RV systolic functionTDI systolic S’ velocity < 11cm/s correlates with RVEF <45%RV 2-D strain <-20 is considered abnormal
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Thank you for your Attention!!!